A year ago, competitors were out to produce their own versions of Pfizer's Exubera, the inhalable insulin. However, now it's clear that Exubera is a bomb. Yes, a slick new ad campaign might revive its fortunes, so don't count Exubera out of the race quite yet. But it's not likely to be the blockbuster product many thought it could be.

Now the fallout is hurting those companies that were scrambling to compete/cash in by producing their own inhalable insulins. According to a report in Forbes, those same companies are ready to beat a smart retreat. Meanwhile, they're trying to reassure nervous investors. Case in point: MannKind Corp. shares fell nearly ten percent on Monday after it was announced the company could take longer to line up a partner for its inhalable insulin, the Technosphere Insulin System.

Not only that, MannKind postponed the release of its second quarter financial report. Wall Street analysts downgraded the stock, saying its short-term outlook is "challenged" and cited disappointing sales of Exubera as a factor. The outlook could be even worse if it looks like insulin caps will make it to market. As I said in a previous blog on that topic, who wants to tote a bulky inhaler around if you can pop some capsules instead?

Remember back in 2006 all the buzz surrounding Exubera, Pfizer's inhalable insulin product? It was much-hyped by Pfizer and, let's face, the media happily joined in too, spreading the word that (as Pfizer would have it) Exubera would be wildly successful and make squillions of dollars for investors.

It didn't work out that way at all. Sales so far have topped out at around four million dollars per quarter, far short of the two billion projected before the product was released. Now, in a bid to lift lackluster sales, Pfizer is launching a major ad campaign for Exubera. Yes, the inhaler device is extremely indiscreet. Yes, long-term use of the drug itself could cause lung damage. Oh, and health insurers may not cover prescriptions for Exubera for those diabetics who want to try it. But I guess where there's a slick selling strategy there's a way...into the pockets of consumers, that is.

Which is not to say I blame Pfizer. The company has poured so much money into this product, does it really have a choice at this point? No. Also, it's entirely possible Pfizer could turn things around. This article by Arlene Weintraub for Business Week reminds readers that the drug giant had enormous success with its clever ad campaigns for Viagra and for the incontinence drug Detrol. Writes Weintraub, this new campaign will probably cost Pfizer big-time: we're talking tens of millions of dollars, but it will be worth it for Pfizer if it can reproduce that kind of success.

If at first you don't succeed - go straight to the patient's home. After a lackluster attempt to sell doctor's on prescribing Phizer's inhalable insulin, Exubera, the company has decided to begin running television and print campaigns to advertise directly to patients.

The ads will start appearing the second half of 2007. However the main contention from Congress and medical groups is that mass marketing to patients encourages excessive use of costly therapies. Exubera gained a reputation for being an over priced and not-so-discreet way to administer insulin. Doctors say the inhaler is unwieldy. Depending on a patient's health care plan, they can pay about $600 a year more for Exubera than injectable forms of insulin. Clinical trials have found the product can reduce lung function for some patients. Pfizer says the condition is reversible and is conducting a five-year study among users to monitor it.

Why the push, Pfizer? You seem hell-bent on making this one stick. The president of Pfizer's worldwide pharmaceutical operations says the television ads will target newly diagnosed diabetics who may not want to inject themselves daily. Patients who develop diabetes later in life may put off using insulin because of needle phobia. Fair tradeoff: I see your fear of needles and raise you $600 a year, a license to toke (in public), and maybe a little bruising on your alveoli. Puff, puff...give it a shot.